A-2300 Case Disposition

Revision 19-2; Effective April 1, 2019

A—2310 Notice to Applicants

Revision 15-4; Effective October 1, 2015

All Programs

Eligibility Determination Group (EDG) disposition produces the individual's notice of eligibility status. At the close of the interview or during processing of the application or renewal form, the EDG is pended, certified, sustained or denied. Advisors must give the individual one or more of the following notices:

Form H1020 , Request for Information or Action — Form H1020 tells the individual the:

reason the case is pending;

action the individual or advisor must take;

date by which the individual or advisor must take action; and

date the advisor must deny the application/EDG if the individual does not take action, if applicable.

Note: For Spanish-speaking only individuals, advisors must ensure that all comments provided are in Spanish. See Form H1020 instructions for translation of common pending phrases.

Form TF0001, Notice of Case Action

If benefits have been approved, the notice informs the individual of:

the date benefits begin or Medicaid effective date;

the amount of benefits; and

the length of certification for Supplemental Nutrition Assistance Program (SNAP) EDGs.

If benefits have been denied, terminated or reduced, the notice informs the individual of:

the reason the advisor denied the application, denied the EDG or reduced benefits;

that a protective payee is required for Temporary Assistance for Needy Families (TANF);

the effective date of the action;

the individual’s right to appeal;

the address and telephone number of free legal services available in the area; and

that the advisor used a credit report, if its use resulted in fewer benefits than the individual would have otherwise received.

If an application is denied because an individual failed to keep an appointment or furnish information, advisors provide what they must do to reuse the application.

Note: Eligibility for multiple programs is determined independently of each other. Advisors must not deny an application for one program based solely on the denial of another program unless the household fails to meet the eligibility requirements.

If the advisor issued a notice of eligibility for the one-time grandparent payment but State Office Database Support notifies the advisor that the individual is not eligible, Form TF0001, Notice of Case Action, is issued to notify the household that they are not eligible because they previously received the payment.

A—2320 Eligibility Dates and Benefit Amounts

Revision 08-1; Effective January 1, 2008

A—2321 Date Eligibility Begins

Revision 15-4; Effective October 1, 2015

TANF

TANF financial eligibility begins the earlier of the:

certification date; or

30th day after the file date.

The certification date is the date the advisor disposes the TANF EDG. An applicant must receive benefits for the month that falls within 30 days of the file date, unless benefits prorate to less than $10.

Note: Advisors must not prorate OTTANF or One-Time Grandparent payments.

SNAP

Advisors base proration on the number of days between the file date and the end of the month. To calculate the prorated amount, advisors determine the:

household's whole monthly benefit based on household size and net income; and

prorated allotment from the proration table in C-1432, Prorated SNAP Allotments by Application Date, using the whole monthly allotment and date of application.

Note: Advisors never prorate benefits for any month after the application month.

To calculate prorations over $300, advisors must:

Subtract the date of application from 31.

Multiply the difference by the amount of the whole monthly allotment.

Divide that amount by 30.

Drop all cents.

If the date of application is the 30th or 31st, advisors divide the whole allotment by 30.

Example: A household applies June 17. The household's whole monthly allotment is $395.

31 - 17 = 14

$395 × 14 = $5,530

$5,530 ÷ 30 = $184.33

Round to $184. The household's prorated allotment for June is $184.

Advisors must not prorate benefits if the household includes a member who meets both of the following criteria:

is a seasonal or migrant farm worker (in or out of the workstream); and

was certified for SNAP, in Texas or another state, the month before the household applied.

A—2324 Length of Certification

Revision 15-4; Effective October 1, 2015

TANF

TANF does not have a certification period. The EDG remains open until denied.

The Texas Integrated Eligibility Redesign System (TIERS) calculates the TANF periodic review due date from the date the advisor disposes the EDG as follows:

Applications:

11 months for payee EDGs with income of less than $3; or

five months for other EDGs.

Reviews:

12 months for payee cases with income of less than $3; or

six months for other cases.

One-Time Payments

OTTANF cases are not subject to periodic reviews. Applicants must reapply for subsequent benefits after the ineligibility period. See A-2400, One Time Payments. Grandparent OTTANF are not subject to further action.

SNAP

Non-Public Assistance (NPA) Households

Advisors assign households the longest certification period possible based on their eligibility and the predictability of their circumstances, according to the following table:

Exception: Certify SNAP for four or five months, if necessary, so the new SNAP certification period ends one month before the end of the Children’s Medicaid certification period. This will allow state office to mail only one redetermination packet for both programs.

consists entirely of unemployable or elderly persons with stable circumstances and the household does not meet the SR criteria,

six to 12 months.

Example: Households whose members receive Retirement, Survivors and Disability Insurance (RSDI), Supplemental Security Income (SSI), retirement pensions or disability payments may be certified up to 12 months if other household circumstances are expected to remain stable.

does not meet the SR criteria and circumstances are unstable (including households with an able-bodied adult without dependents [ABAWD]),

three to six months.

is likely to become ineligible in the next two months due to an expected change and the household does not meet the SR criteria,

one or two months.

Example: The household does not meet SR criteria and the individual indicates during the interview that someone in the household will start a new job, begin receiving unemployment benefits or move out of (or into) the household.

Exception: If the household is certified for one or two months and the certification occurs after the 15th day in the last month of certification, extend the certification to the following month (unless the household is ineligible based on a change known at certification).

Notes:

If a household meets the SR criteria, advisors must ensure that TIERS designates the EDG as SR and assigns a six-month certification period. This includes households with self-employment income.

Advisors must give the individual Form H1010, Texas Works Application for Assistance — Your Texas Benefits, and Form H1830-R, Texas Works Renewal Notice, at recertification when assigning a:

one- or two-month certification period, or

three-month certification period and the case is certified after cutoff in the first benefit month.

Public Assistance (PA) Households

Most SNAP EDGs with associated TANF EDGs meet the SR criteria.

For non-SR households, advisors assign a certification period that meets the requirements listed above for Non-PA households and corresponds to the redetermination due date of the associated TANF EDG.

For SR households, advisors assign a six-month certification period regardless of whether the certification period corresponds to the redetermination due date of the associated TANF EDG.

TP 08

TP 08 has a 12-month non-continuous eligibility certification period. The estimated eligibility end date is estimated as follows:

Applications — application month plus 11 months, and

Redeterminations — 12 months from the last review date.

TP 43, TP 44 and TP 48

The certification period for a child is the earliest of:

12 months, or

through the month of the child’s 19th birthday.

For these Types of Assistance (TOAs), the first six-month period is a continuous eligibility period and the second six-month period is a non-continuous eligibility period. The estimated eligibility end date is estimated as follows:

Applications — application month plus 11 months, and

Redeterminations — 12 months from the last review date.

Emergency Medicaid

Emergency Medicaid ends the earlier of either the end date of the emergency condition or the last day of the application month.

TP 40

The end date is the last day of the second month following the expected delivery date. See A-825, Medicaid Termination, for information on pregnancies that terminate early or late.

TP 45

TIERS calculates an end date that is 12 months from the child's birth date. A newborn is continuously eligible for TP 45 through the month of the child's first birthday, as long as the child lives in Texas.

A—2330 Setting Special Reviews

Revision 16-2; Effective April 1, 2016

TANF and Medical Programs

Advisors assign a special review when certifying a household that anticipates a change affecting eligibility before the next redetermination.

SNAP, TANF and Medical Programs

Advisors set special reviews when the household:

has questionable circumstances; or

includes a pregnant household member whose baby is expected before the next redetermination. Advisors schedule the special review on the first day of the month after her baby is due.

Exception: Advisors must not set a special review for SNAP SR households.

SNAP

Advisors set a special review for SNAP households according to the following chart:

For households ...

assign a special review ...

not designated as streamlined reporting,

when the household anticipates a change affecting eligibility before the next redetermination.

designated as streamlined reporting,

when the household anticipates they will have an increase in income that will cause the household to exceed 130 percent of the Federal Poverty Income Limits (FPIL);

if at certification, the advisor is aware a household member will gain or lose alien status eligibility sometime during the certification period (for example, a lawful permanent resident [LPR] will reach the 5 years of qualifying immigrant status during the certification period); or

when the household reports that an ABAWD who is currently eligible but is not meeting the average 20 hours a week work/training requirement moves into the SR household and will exhaust the individual's time limits and become ineligible on or before the last month of the certification period.

TP 43, TP 44 and TP 48

If a change is reported during the continuous eligibility period, the advisor must schedule a special review in the first week of the sixth month of the certification period, before cutoff, so an expected change can take effect during the non-continuous eligibility period.

A—2330.1 Special Reviews for Known Changes

Revision 15-4; Effective October 1, 2015

SNAP

A known change is a change that the household reasonably anticipates will occur during the certification period.

Example: The individual has been employed in the past by the school district and will return to work at that job three months into the certification period.

Advisors must contact the household to confirm that a change occurred. If the household confirms that a change occurred, policy in B-600, Changes, applies. If the household confirms that no change occurred, the advisor must document in Case Comments the household's explanation to complete the special review.

If the advisor requests verification of the change on Form H1020, Request for Information or Action, Request for Information or Action, but the individual fails to respond, the advisor must consider the case situation questionable and follow procedures in B-635, Shortening Certification Periods as a Result of a Change, to shorten the certification period. Exception: Advisors must not shorten the certification period for SNAP SR households.

A—2330.2 Special Reviews for Questionable Changes

Revision 15-4; Effective October 1, 2015

SNAP

A questionable change is a change the household thinks may happen during the certification period or that the advisor expects to happen because the household's situation is unstable.

Example 1: The individual is unemployed at the time of the interview and is looking for work but does not have a definite job offer.

Advisors must contact the household to determine whether a change occurred. If the household confirms that a change occurred, the advisor follows policy in B-600, Changes. If the household confirms that no change occurred, the advisor documents the contact in Case Comments and the household's explanation to complete the special review.

Note: Advisors must not set a special review due to questionable changes for SNAP SR households.

All Programs

A—2341 Denial of an Application

Revision 17-2, Effective April 1, 2017

All Programs

Denials are effective immediately. Advisors must provide the applicant with Form TF0001, Notice of Case Action, stating the reason for the denial. Advisors must follow the procedures and time frames in B-100, Processes and Processing Time Frames.

Note: Advisors determine eligibility for multiple programs independently of each other and do not deny an application for one program based solely on the denial of another program unless the household fails to meet the eligibility requirements.

Medical Programs

The system automatically sends individuals determined ineligible for Medicaid and the Children’s Health Insurance Program (CHIP) at application to the Marketplace for an eligibility determination for federal health care coverage programs.

To qualify for the federal health care coverage programs, all individuals must first be determined ineligible for Medicaid and CHIP. Advisors must test whether an individual is eligible for all Medical Programs. The Texas Works Medical Programs Hierarchy, explained in A-132.1, Medical Programs Hierarchy, does this automatically for all clients at application.

Notes:

Advisors must follow a manual process when retesting eligibility for a minor parent aging out of TP 44, a pregnant woman from TP 40 at the end of the certification period, or an individual at the end of the transitional Medicaid certification period, as explained in A-2342.1, Retesting Eligibility.

Pregnant woman whose TP 40 coverage terminates prior to the end of their original certification period may be eligible for automatic retesting of eligibility for all Medical Programs as explained in A-825, Medicaid Termination.

A—2342 Denial at Redetermination

TANF

SNAP

Denials are effective immediately. Advisors provide the household with Form TF0001, Notice of Case Action, stating the reason for denial.

Timely Redeterminations — If a household applies by the 15th of the last month of their certification period and is ineligible, advisors use the policy and procedures in B-120, Redeterminations, to deny the EDG.

Untimely Redeterminations — If a household applies after the 15th of the last month of their certification period and is ineligible, advisors use the policy and procedures in B-110, Applications, to deny the EDG.

Medical Programs

The system automatically sends individuals determined ineligible for Medicaid and CHIP at redetermination to the Marketplace for an eligibility determination for federal health care coverage programs.

To qualify for the federal health care coverage programs, all individuals must first be determined ineligible for Medicaid and CHIP. Advisors must test whether an individual is eligible for all Medical Programs. The Texas Works Medical Programs Hierarchy, explained in A-132.1, Medical Programs Hierarchy, does this automatically for all clients at redetermination.

Notes:

Advisors must follow a manual process when retesting eligibility for a minor parent aging out of TP 44, a pregnant woman from TP 40 at the end of the certification period, or an individual at the end of the transitional Medicaid certification period, as explained in A-2342.1, Retesting Eligibility.

Pregnant woman whose TP 40 coverage terminates prior to the end of their original certification period may be eligible for automatic retesting of eligibility for all Medical Programs as explained in A-825, Medicaid Termination.

TP 08

Before denying for missing a redetermination appointment, advisors must determine whether the individual is eligible for TP 07 in the denial effective month. If so, advisors provide TP 07 rather than denying the EDG.

TP 43, TP 44 and TP 48

Advisors process a denial if the household fails to provide pending verification by the 30th day from the file date or by cutoff in the last benefit month of certification, whichever is later. Advisors do not provide 13 days advance notice prior to denying the EDG.

When an advisor processes a renewal, which results in a shortened Medicaid certification period, the household may be eligible for expedited CHIP enrollment as explained in D-1711, Expedited CHIP Enrollment.

A—2342.1 Retesting Eligibility

Revision 15-4; Effective October 1, 2015

TP 44, TP 40, TP 07 and TP 20

The advisor must retest the following clients’ potential eligibility for other Medical Programs by manually running the Texas Works Medical Program Hierarchy explained in A-132.1, Medical Programs Hierarchy, from the beginning:

Minor parents aging out of TP 44, Children Ages 6-18;

Individuals under TP 40, Pregnant Women, once their certification period ends; and

Individuals terminated from TP 07 or TP 20, transitional Medicaid.

All other clients will flow through the hierarchy to either the next available program (for example, a child aging out of TP 48 will automatically be tested for TP 44) or will be referred to the Marketplace if determined ineligible for all other Medical Programs (for example, a non-parent child aging out of TP 44).

The system will not terminate eligibility of the individuals listed above at the end of the certification period. An advisor must take action to review the individual's eligibility and re-run the hierarchy to determine potential eligibility for other programs. Advisors must use the first day of the last month of the current certification period as the file date. Advisors should treat these cases like a redetermination without an actual renewal form. Except in the case of TP 40 where there may be an application, in which case advisors would process the case as they do redeterminations with renewal forms. Advisors must verify information as is currently done in the redetermination process.

The remaining individuals in the client’s household composition are not re-evaluated for eligibility during a continuous eligibility period. Changes to household composition for the aging out of minor parents, end of pregnancy, or termination of transitional Medicaid coverage will be acted upon once the individuals transition from a continuous eligibility period to a non-continuous eligibility period.

A—2343.1 How to Take Adverse Action if Advance Notice Is Required

Revision 15-4; Effective October 1, 2015

All Programs

TIERS provides 13 days advance notice to the household after informing them of a denial or termination of ongoing benefits using Form TF0001, Notice of Case Action. The day Form TF0001 is sent is day zero of the adverse action period.

If the 13-day advance notice period:

does not expire until after the last day of the month (regardless of whether the 13th day is a workday), the household is eligible for the same level of benefits the month after the notice was sent.

expires between cutoff and the end of the month and the reduction or denial is effective the following month, advisors generate Form TF0001, Notice of Case Action. Note: Advisors do not deny TP 40 EDGs when taking adverse action for failure to provide postponed verification.

TANF

Advisors provide 13 days advance notice to the household using Form TF0001 before taking action to:

At complete redetermination, advisors re-evaluate the situation to determine whether the protective payee should continue. If the decision is to continue, the advisor notifies the individual by Form TF0001.

If the individual appeals this decision, the advisor issues TANF benefits to a protective payee until the hearing is completed.

A—2344 Adverse Actions Not Requiring Advance Notice

Revision 13-2; Effective April 1, 2013

A—2344.1 Form TF0001 Required (Adequate Notice)

Revision 15-4; Effective October 1, 2015

All Programs

The following situations require that the household be provided adequate notice:

The individual's location is unknown, and the post office returns Texas Health and Human Services Commission (HHSC) mail with no forwarding address.

The head of the household, authorized representative or other responsible household member:

in the HHSC advisor's presence (in the office or by telephone) verbally volunteers to withdraw; or

gives HHSC a written, signed report of change, and the advisor determines the:

exact amount of the reduced benefits, or

that the household is ineligible.

Note: This includes situations in which the advisor receives Form H1028, Employment Verification, signed by the individual and completed by the employer.

The household reports in advance they will move out of state.

Employment and Training (E&T) noncooperation is received in the last benefit month.

Related Policy
How to Report, B-623
Sending Notice of Failure to Cooperate, A-1845.1

TANF and Medical Programs

In the following situations, advisors send Form TF0001, Notice of Case Action, without advance notice:

The advisor denies or reduces benefits when an individual reaches the maximum age as described in A-220, TANF, and A-240, Medical Programs.

The advisor confirms the individual's or payee's death when no relative is available to serve as new payee.

The advisor reduces the grant or denies a Medical Program individual because the individual received a new TANF or SSI grant.

The advisor imposes a full-family sanction because of noncooperation with one or more Personal Responsibility Agreement (PRA) requirements.

The advisor denies a TP 08 individual because of noncooperation with medical support.

The individual was admitted/committed to an institution and no longer qualifies for TANF or Medical Programs benefits.

The individual was placed in skilled nursing care or intermediate care.

The advisor denies a TANF or TANF-State Program (SP) EDG because the caretaker or second parent received their lifetime limit of 60 months.

HHSC verifies an individual is certified for SSI or TANF in another state.

A TANF or Medical Program child is removed from the home by court order or voluntarily placed in foster care by the legal guardian.

SNAP

In the following situations, advisors send Form TF0001 without advance notice:

The household fails to provide verification postponed during expedited services, or provides postponed verification that results in lowered or denied benefits.

The advisor discovers information an expedited household failed to report. The information:

exists on the interview date,

results in lowered or denied benefits, and

is discovered between the time the application is approved with postponed verification and on or before the 30th day.

A drug and alcohol treatment/group living arrangement facility loses its status as authorized representative or loses its certification.

Centralized Benefit Services (CBS) contacts field staff to deny the SNAP EDG in order to certify the SNAP Combined Application Project (SNAP-CAP) EDG. Note: If the SNAP-CAP applicant is certified for SNAP with other household members, allow advance notice of adverse action before removing the individual from the existing SNAP EDG.

A—2344.2 No Form TF0001 Required

All Programs

Form TF0001, Notice of Case Action, is not required in the following situations:

the state or federal government initiates mass changes that affect the entire caseload or significant portions of the caseload, such as the annual Social Security cost-of-living adjustment.

the household moves out of state and reports it afterward.

the household gives HHSC a written, signed request to voluntarily withdraw.

TANF

Form TF0001 is not required when child support collected by the Office of the Attorney General exceeded the amount of the grant plus the $75 disregard. In these cases, state office sends Form H1718, Notice of Benefit Denial, to the individual.

SNAP

Form TF0001 is not required in the following situations:

All members of a household have died.

The individual's allotment changes from month to month during the certification period because of changes expected at the time of certification. In this situation, inform the individual on Form TF0001 at the time of certification that the household's allotment will vary.

The individual applied for TANF and SNAP at the same time and received SNAP while waiting for approval of the TANF grant.

A—2350 Streamlined Reporting Households

Revision 19-2; Effective April 1, 2019

SNAP

All SNAP households meet the streamlined reporting criteria with the following exceptions:

The household knows (at application or redetermination) they have a change that will make them ineligible within the next six months. For example, the household plans to move out of state due to a new job in two months. Note: Do not consider an anticipated change in household composition as a known change until it actually occurs.

The household consists of members who are all elderly or who have a disability, and no member has earned income. These households include pure SSI and RSDI cases that normally receive a 12-month certification period. Use the criteria in B-430, Households with Elderly Members or Members with a Disability, to determine if a person is elderly or has a disability for SR. If all household members meet the criteria in B-430, at least one member must have earned income to be designated as SR.

The household contains at least one non-exempt ABAWD. For SR purposes, an adult age 18 up to age 50 is not considered an ABAWD if exempt from the SNAP ABAWD work requirement due to:

disability;

having a child under age 18 (or is a member of a SNAP EDG where a household member is under age 18); or

pregnancy.

Notes:

A single-person household meets the SR criteria if the individual has a disability. If the disability is not obvious, the advisor should obtain Form H1836-A, Medical Release/Physician's Statement. This person does not have to meet the earned income stipulation to be designated as SR.

A single-person ABAWD living in a SNAP ABAWD waiver or non-E&T county does not meet the SR criteria.

In situations where a household member is working or training an average of 20 hours weekly and has a child under age 18 (or is a member of a SNAP EDG where a household member is under age 18), the advisor must exempt the household member as having a child under age 18 in the 18-50 Work Requirement screen.

When an SR household reports that an ABAWD is working or participating less than an average of 20 hours per week and no longer meeting the work requirement, the household will be subject to non-streamlined reporting criteria.

Advisors must determine whether a household meets the SR criteria at application and redetermination. Advisors assign a certification period to SR households, as explained in A-2324, Length of Certification, and do not remove the SR designation at incomplete reviews. The household retains its SR designation throughout the certification period.

A—2351 Disqualified Members

Revision 16-2; Effective April 1, 2016

SNAP

Advisors must extend SR policy to households containing disqualified members. In a household containing all elderly and/or members with a disability, the household can meet the SR criteria, even if the disqualified member is the only person with earnings.

Advisors do not consider a disqualified member an ABAWD for purposes of determining SR status, even if the member is disqualified due to exhausting the individual's SNAP ABAWD time limits. Advisors consider only eligible household members for this purpose.

A—2360 Documentation Requirements

Revision 15-4; Effective October 1, 2015

All Programs

Documentation must be sufficient to support the advisor's decision for denying or terminating the EDG. Refer to C-940, Documentation, for requirements related to adverse action decisions.

If not obvious, advisors must document that:

adequate notice was allowed according to policy in A-2344.1, Form TF0001 Required (Adequate Notice); or

Form TF001, Notice of Case Action, was not required according to policy in A-2344.2, No Form TF0001 Required.

TANF and Medical Programs except Emergency Medicaid

Advisors must thoroughly document the reason for any special review and explain any information needed and the acceptable verification required to clear the review.

SNAP

Advisors must document the:

reason for extending a certification period;

reason for modifying the designators or override tab; and

reason for setting a special review, thoroughly explaining why the special review was set, any information needed, and the acceptable verification required to clear the review.